The recent meeting of the European League Against Rheumatism (EULAR) continued to present more data on the tumor necrosis factor (TNF) inhibitors, Enbrel, Remicade and Humira. And these drugs continue to impress.
However, the jury is out as to whether every rheumatoid arthritis patient needs the TNF drugs. It does appear that more aggressive and creative use of the more traditional drugs used in the treatment of rheumatoid arthritis can be extremely effective also.
The EULAR conference discussed data which demonstrated that in early rheumatoid arthritis the proportion of patients achieving remission in each of the following groups was comparable: patients treated with sequential mono therapy beginning with methotrexate; patients treated with gradual "step-up" combination therapy; patients treated with combination therapy including high dose prednisone; and patients initially treated with methotrexate and Remicade.
Despite this, it was found that damage to the joints as demonstrated by x-rays was less in those patients treated with the combination therapy and high dose prednisone, and in those patients treated from the outset with methotrexate and Remicade. Also, patients felt subjectively better on the Remicade-first regimen, and they did so well that, compared to the other patient groups, it was not felt that they needed a change in their therapy. Still, how does a doctor-or a patient-know if he or she will eventually need a TNF drug? Hopefully, further research will answer that question.
Published On: August 16, 2007